Background In the aging world digital technologies are needed to target the health needs of older people. This study aimed to identify digital technologies for health promotion and disease prevention for older people by performing a scoping review. Methods A search of MEDLINE, PsycINFO, CINAHL and SCOPUS on 09.03.2022 identified 2150 studies. The inclusion criteria were: 1) Population: older people, 2) Concept: any digital health technology, 3) Context: health promotion and disease prevention in home or community settings. Preliminary study selection was performed automatically using the smart groups function in EndNote. Studies were clustered by digital technology type, health target, study design and study focus. Final study selection and data coding will be performed manually by two authors. Results Of the 2150 studies, 1874 studies were excluded, 159 studies met the inclusion criteria 1) and 2), but addressed different contexts (digital competence, digital technology development, disease management) or setting (care) and 117 studies were included. Digital technology types were: 1) any technologies (digital, virtual, video, eHealth or telehealth), 2) internet websites accessed via computer, 3) SMS or mobile phones, 4) exergaming or 5) smartphones or wearables. Health targets were: 1) physical activity, 2) mental health and wellness, 3) nutrition or 4) cognitive functioning. Study designs included primary studies (randomized-controlled trials) or reviews (systematic or scoping). Study focus was on effectiveness, feasibility or evaluation of digital technologies. Conclusions The health needs of older people are addressed by older technologies. Newer studies use heterogeneous terminology when referring to digital technologies. Future studies should focus on multiple aspects of healthy aging beyond mobility. More work is also needed to understand if and how a shift towards newer technologies occurs and if that is associated with health benefits in older people. Key messages • Older digital technologies (computers and mobile phones) address the health needs of older people. • Mobility is the main health target of digital technologies for older people in the context of health promotion and disease prevention.
Background Appropriate dissemination of public health evidence is of high importance to ensure that relevant knowledge reaches potential stakeholders and relevant population groups. A wide distrust towards science and its findings indicates that communication thereof remains below its potential. Cochrane Public Health (CPH) provides an important source of high-quality scientific evidence. This study aimed to identify (1) dissemination strategies and (2) possible stakeholders of Cochrane Public Health reviews. Methods This is a cross-sectional, meta-research study. All 68 records (reviews or protocols) listed on the CPH website https://ph.cochrane.org/cph-reviews-and-topics up to 08.03.2022 were included. Record characteristics, dissemination strategy information and potential stakeholder details were coded by one author and 10% of records were checked by another author. Data were descriptively analysed. Results 53 reviews (46 systematic reviews, 6 rapid reviews, 1 scoping review) and 15 review protocols were included. The 53 reviews were published between 2010-2022 and included 1-153 primary studies. All reviews had an open-access plain language summary (PLS) in English with translations in 3-13 other languages. Although 16 of 53 reviews and 4 of 15 protocols reported any involvement in the review process of an advisory group, only 3 of 68 records included a dissemination plan aiming to inform non-academic audiences or policy. Conclusions All identified records can be considered as relevant to a wide range of stakeholders and population groups. However, CPH reviews or protocols rarely report their dissemination strategies. It is unclear what dissemination strategies are used after CPH reviews are published. High relevance of CPH evidence for non-academic stakeholders and the general population highlights the need for adequate knowledge translation beyond academia. Key messages • Dissemination plans and implementation is rarely reported in CPH reviews. • Evidence from CPH reviews is relevant for a multitude of stakeholders.
Purpose This systematic review and dose-response meta-analysis aimed to investigate the relationship between hospital volume and outcomes for total knee arthroplasty (TKA). Methods MEDLINE, Embase, CENTRAL and CINAHL were searched up to February 2020 for randomised controlled trials and cohort studies that reported TKA performed in hospitals with at least two different volumes and any associated patientrelevant outcomes. The adjusted effect estimates (odds ratios, OR) were pooled using a random-effects, linear dose-response meta-analysis. Heterogeneity was quantified using the I 2 -statistic. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively. Results A total of 68 cohort studies with data from 1985 to 2018 were included. The risk of bias for all outcomes ranged from moderate to critical. Higher hospital volume may be associated with a lower rate of early revision ≤ 12 months (narrative synthesis of k = 7 studies, n = 301,378 patients) and is likely associated with lower mortality ≤ 3 months (OR = 0.91 per additional 50 TKAs/year, 95% confidence interval [0.87-0.95], k = 9, n = 2,638,996, I 2 = 51%) and readmissions ≤ 3 months (OR = 0.98 [0.97-0.99], k = 3, n = 830,381, I 2 = 44%). Hospital volume may not be associated with the rates of deep infections within 1-4 years, late revision (1-10 years) or adverse events ≤ 3 months. The confidence in the cumulative evidence was moderate for mortality and readmission rates; low for early revision rates; and very low for deep infection, late revision and adverse event rates. Conclusion An inverse volume-outcome relationship probably exists for some TKA outcomes, including mortality and readmissions, and may exist for early revisions. Small reductions in unfavourable outcomes may be clinically relevant at the population level, supporting centralisation of TKA to high-volume hospitals. Level of evidence III. Registration numberThe study was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019131209 available at: https:// www. crd. york. ac. uk/ prosp ero/ displ ay_ record. php? Recor dID= 131209). KeywordsTotal knee arthroplasty (TKA) • Knee osteoarthritis • Hospital volume • Hospital volume-outcome relationship • Systematic review • Dose-response meta-analysis * C. M. Kugler
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